摘要
目的:评价目前心房颤动(房颤)射频导管消融术中抗凝方案的有效性和不同抗凝药对术中凝血状态的影响。方法:筛选2015年12月至2017年3月于我院行房颤射频导管消融术的患者163例,其中158例术前接受有效抗凝治疗的患者均纳入研究。根据患者服用不同药物分为三组:华法林组86例、达比加群酯组51例和低分子肝素(LMWH)组21例。分析患者房间隔穿刺后首剂肝素后活化凝血时间(ACT)达标率(First-ACT达标率)、穿间隔后1 h ACT达标率(1 h-ACT达标率);比较三组间基础ACT值、First-ACT达标率、1 h-ACT达标率、ACT首次达标耗时、术中肝素总量情况。结果:158例患者中基础ACT结果:华法林组最接近有效范围,且三组间比较差异有统计学意义(P<0.001);与达比加群酯组及LMWH组比较,华法林组的First-ACT达标率及1 h-ACT达标率明显升高,而ACT首次达标耗时和术中肝素总量明显减低,差异均有统计学意义(P均<0.05);达比加群酯组及LMWH组比较差异无统计学意义(P>0.05)。结论:目前临床上参考体重和ACT监测给予肝素的术中抗凝策略因未考虑不同术前抗凝药物对基础ACT的影响而存在缺陷。该策略下达比加群酯抗凝的房颤患者术中整体ACT达标率显著低于华法林组,提示该群体围术期心房血栓形成和栓塞事件的潜在风险增高,应考虑适当增加首剂肝素量以提高该组围术期抗凝效果。
Objectives:To evaluate the efficacy of the present perioperative anticoagulant strategy and the impact of different anticoagulant drugs on achieving intraoperative standard activated clotting time(ACT)during catheter ablation of atrial fibrillation.Methods:Patients with atrial fibrillation who received catheter ablation between December,2015 and March,2017 in our center were screened.Inclusion criteria:the patients who received 3 weeks of warfarin with therapeutic INR or standard dosage(110 mg bid)of dabigatran;the patients with low risk of embolism(males with CHA2DS2-VASc≤1 and females with CHA2DS2-VASc≤2)who received low molecular weight heparin(LMWH)for 3 days when they were admitted to hospital.Anticoagulant therapy was not discontinued for all the patients before ablation.Heparin was continuously prescribed within the intraoperative period and the dosage was based on the ACT value monitored constantly during procedure.The baseline ACT value,ACT targeting rate after the first dose of heparin after atrial septal puncture(First-ACT%),ACT targeting rate of 1 hour after atrial septal puncture(1 h-ACT%),the time used to reach the first goal ACT,and total dosage of heparin used within the intraoperative period were compared among the 3 groups.Results:The First-ACT%and 1h-ACT%for the whole study population were 44.3%and 56.9%respectively.The basic ACT values of the warfarin group,the dabigatran group and the LMWH group had notable difference(P<0.001);the First ACT%and the 1 h-ACT%of the warfarin group were significantly higher than those of the other two groups(P<0.05);the time used to reach the first goal ACT(P<0.001)and the total amount of heparin(P<0.001)in the warfarin group were significantly lower than those in the other two groups.Conclusions:For the patients with atrial fibrillation,the difference in coagulation status during abaltion procedure with different anticoagulants still existed even though they received standard and effective anticoagulants.The perioperative anticoagulant effectiveness in the w
作者
施姣姣
颜清
杨沭
郦明芳
陈明龙
居维竹
季玲
SHI Jiaojiao;YAN Qing;YANG Shu;LI Mingfang;CHEN Minglong;JU Weizhu;JI Ling(Department of Cardiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing(210029),Jiangsu,China)
出处
《中国循环杂志》
CSCD
北大核心
2022年第5期465-471,共7页
Chinese Circulation Journal
基金
江苏省科技厅临床前沿技术项目心房颤动患者脑卒中二级预防立体化策略研究(BE2017750)。
关键词
心房颤动
射频导管消融
活化凝血时间
华法林
达比加群酯
atrial fibrillation
radiofrequency ablation
activated clotting time
warfarin
dabigatran
